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Yelak A, From A, Gilad O, Brik Simon D, Rubin S, Cohen M, Amarilyo G, Levin C, Bakry D, Izraeli S, Tamary H, Yacobovich J, Steinberg-Shemer O. Symptomatic corpus luteum hemorrhage in adolescent females with ITP. Eur J Pediatr 2024:10.1007/s00431-024-05560-0. [PMID: 38602530 DOI: 10.1007/s00431-024-05560-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 04/01/2024] [Accepted: 04/04/2024] [Indexed: 04/12/2024]
Abstract
Patients with immune thrombocytopenia (ITP) usually present with minor mucocutaneous bleeding. Corpus luteum hemorrhage (CLH) is generally asymptomatic but may, rarely, lead to severe intraperitoneal bleeding, mostly in patients with coagulation disorders. CLH causing intraperitoneal bleeding has only been described in few individuals with ITP. The objective of this retrospective observational study was to assess the clinical course and incidence of symptomatic CLH in adolescent females with newly diagnosed or chronic ITP. Additionally, a comprehensive literature review was conducted to scrutinize cases of pediatric female patients with ITP, complicated by CLH. We identified three patients with ITP and hemoperitoneum secondary to CLH. They presented with acute abdominal pain, had severe thrombocytopenia (platelet counts below 20 × 109/L), and required blood transfusions as well as ITP-directed therapy. All the patients were hemodynamically stable and did not require emergency surgical intervention. Conclusion: CLH could potentially pose a significant complication in the context of adolescent females with ITP, requiring a strong index of suspicion to direct expedient therapy. What is Known: • Immune thrombocytopenia is typically associated with minor bleeding tendency. • Corpus luteum hemorrhage is generally asymptomatic; however, in women with bleeding disorders, it has the potential to result in substantial intra-abdominal bleeding. What is New: • Corpus luteum hemorrhage leading to intra-abdominal bleeding is a potential severe complication of immune thrombocytopenia in adolescent females.
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Affiliation(s)
- Alexander Yelak
- Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Anat From
- Gynecology Clinic for Girls and Adolescents, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Oded Gilad
- Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dafna Brik Simon
- Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Shiri Rubin
- Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Miriam Cohen
- Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Gil Amarilyo
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Carina Levin
- Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
- Pediatric Hematology Unit and Research Laboratory, Emek Medical Center, Afula, Israel
| | - Doua Bakry
- Department of Pediatrics, Ziv Medical Center, Safed, Israel
- Azrieli Faculty of Medicine, Safed Regional College, Safed, Israel
| | - Shai Izraeli
- Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hannah Tamary
- Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joanne Yacobovich
- Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Hematological Molecular Diagnostic Laboratory, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Orna Steinberg-Shemer
- Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Pediatric Hematology Research Laboratory, Felsenstein Medical Research Center, Petach Tikva, Israel.
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Abstract
Objective: There are multiple health benefits associated with both breastfeeding and practicing physical activity (PA). Therefore, it is likely that many women might want to engage in both. We designed the current randomized clinical trial to examine the effect of moderate- to high-intensity PA on human milk (HM) volume and macronutrient contents. Methods and Study Design: In this prospective, randomized, crossover clinical trial, we recruited 31 healthy mothers who had been exclusively breastfeeding their infants. Mothers expressed HM twice each day on 2 consecutive days-a day with PA (1-hour before and 1-hour after PA) and a control day without PA (at the exact same hours of the day). The order of days (with/without PA) was determined randomly. Macronutrients and energy contents of HM were analyzed using the Human Milk Analyzer (Miris AB, Uppsala, Sweden). PA was graded according to the Borg Rating of Perceived Exertion scale (RPE scale). Results: A total 124 HM samples from 31 mothers were analyzed. Moderate- to high-intensity PA affected neither macronutrients (fat, carbohydrates, protein) nor energy content. Milk volume remained unaffected by PA as well. Conclusions: Maternal PA does not affect HM volume or its macronutrient contents. Lactating mothers can be reassured regarding their breast milk volume and composition while practicing PA of moderate to high intensity.
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Affiliation(s)
- Moria Be'er
- Department of Pediatrics and Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dror Mandel
- Department of Neonatology, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Yelak
- Department of Pediatrics and Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dana Lihi Gal
- Department of Pediatrics and Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Laurence Mangel
- Department of Neonatology, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ronit Lubetzky
- Department of Pediatrics and Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Yelak A, Marom R, Mandel D, Mangel L, Grisaru‐Soen G, Adler A. Retrospective study showed that bacterial gastroenteritis was an important cause of bloody stools in newborn infants. Acta Paediatr 2019; 108:1781-1785. [PMID: 30896041 DOI: 10.1111/apa.14787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/13/2019] [Accepted: 03/18/2019] [Indexed: 11/29/2022]
Abstract
AIM Acute bacterial gastroenteritis is a major cause of morbidity and mortality, especially in the developing countries. We examined the incidence, clinical features and outcomes in the first week of life. METHODS This was a retrospective study of culture-proven bacterial gastroenteritis in newborn infants that were diagnosed between January 2011 and September 2018 in a tertiary centre in Israel. RESULTS There were 10 cases of culture-proven bacterial gastroenteritis, detected out of 91 stool cultures. All infants were born vaginally and nine were full-term infants. The annual incidence was 0.096 per 1000 live births. The responsible pathogen was Campylobacter in six patients, Salmonella in two and Shigella sonnei in two. The mean age of disease onset was two days of life. Antibiotics were given to five patients, but were inappropriate in two cases. Only one patient with the Shigella sonnei infection required respiratory support. All patients fully recovered. CONCLUSION One in ten newborn infants with bloody stools had bacterial gastroenteritis, contradicting the low rates found in other studies and indicating the importance of considering this diagnosis. Antimicrobials active against Salmonella or Shigella should be given to newborn infants who have bloody stools and look ill.
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Affiliation(s)
- Alexander Yelak
- Department of Neonatology Lis Maternity Hospital Tel‐Aviv Sourasky Medical Center Tel‐Aviv Israel
| | - Ronella Marom
- Department of Neonatology Lis Maternity Hospital Tel‐Aviv Sourasky Medical Center Tel‐Aviv Israel
- Sackler Faculty of Medicine Tel‐Aviv University Tel‐Aviv Israel
| | - Dror Mandel
- Department of Neonatology Lis Maternity Hospital Tel‐Aviv Sourasky Medical Center Tel‐Aviv Israel
- Sackler Faculty of Medicine Tel‐Aviv University Tel‐Aviv Israel
| | - Laurence Mangel
- Department of Neonatology Lis Maternity Hospital Tel‐Aviv Sourasky Medical Center Tel‐Aviv Israel
| | - Galia Grisaru‐Soen
- Sackler Faculty of Medicine Tel‐Aviv University Tel‐Aviv Israel
- Pediatric Infectious Disease Unit Dana Dwek children Hospital Tel‐Aviv Sourasky Medical Center Tel‐Aviv Israel
| | - Amos Adler
- Sackler Faculty of Medicine Tel‐Aviv University Tel‐Aviv Israel
- Clinical Microbiology Laboratory Tel‐Aviv Sourasky Medical Center Tel‐Aviv Israel
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